Pazopanib-associated posterior reversible encephalopathy syndrome with intracerebral haemorrhage

BMJ Case Rep. 2017 Apr 17:2017:bcr2016218221. doi: 10.1136/bcr-2016-218221.

Abstract

Pazopanib is a tyrosine kinase receptor antagonist used for renal cell carcinoma and soft tissue sarcoma that inhibits tumour growth and angiogenesis. A common side effect of pazopanib is hypertension. We report a case of a 69-year-old woman with clear cell renal cell carcinoma who developed a large right occipital intracerebral haemorrhage 3 weeks after initiating pazopanib. Although this was initially suspected to be a haemorrhagic metastasis, MRI revealed bi-occipital oedema, supporting a diagnosis of posterior reversible encephalopathy syndrome (PRES). A craniectomy was required. Immunohistochemical stains for renal cell carcinoma antigen, CA IX and PAX8 were negative. This case suggests that PRES and intracerebral haemorrhage may result from pazopanib use and are important complications to consider prior to initiating this agent.

Keywords: Chemotherapy; Neurology; Neurooncology; Oncology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carcinoma, Renal Cell / drug therapy
  • Cerebral Hemorrhage / etiology*
  • Decompressive Craniectomy
  • Female
  • Humans
  • Indazoles
  • Kidney Neoplasms / drug therapy
  • Magnetic Resonance Imaging
  • Posterior Leukoencephalopathy Syndrome / chemically induced
  • Posterior Leukoencephalopathy Syndrome / diagnostic imaging*
  • Posterior Leukoencephalopathy Syndrome / surgery
  • Pyrimidines / administration & dosage*
  • Pyrimidines / adverse effects
  • Sulfonamides / administration & dosage*
  • Sulfonamides / adverse effects
  • Treatment Outcome

Substances

  • Indazoles
  • Pyrimidines
  • Sulfonamides
  • pazopanib